The Opioid Epidemic In Germany
Germany is the most populous country and the largest economy in the European Union. As such, Germany has attracted the attention of researchers who study the impact of opioids in parts of the world beyond the United States. While many Germans struggle with opioid abuse, a German study published in Deutsches Ärzteblatt last November suggests that opioid abuse in Germany has not reached the severity of the epidemic in America. The differences between healthcare systems in Germany and the United States might explain the discrepancy.
According to the study, survey data from 2000 indicates that 127,000 to 190,000 Germans struggled with an opioid use disorder that year. To determine the number of Germans with an opioid use disorder in 2016, the last year for which complete information is available, the researchers examined data from inpatient and outpatient treatment facilities as well as Germany’s opioid substitution registry.
The aggregated data allowed the researchers to estimate with high confidence the number of Germans with an opioid use disorder in Germany as a whole and in each German state. In 2016, only 0.2% of the German population, or 166,300 people, struggled with opioid addiction. North-Rhine Westphalia, Germany’s most populous region, was home to an estimated 53,851 opioid-addicted Germans, the highest number for any state. Notably, Brandenburg had the lowest estimated number at only 248 people, even though Brandenburg contains Berlin and the state’s population surpasses the populations of several other states.
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Comparisons With The United States
Overall, the number of Germans addicted to opioids from 2000 to 2016 did not dramatically increase, but the number of opioid-related overdoses in America skyrocketed by over 300% during that same timeframe. Meanwhile, Germany did not experience an upward trend in overdoses. For example, the number of opioid-related fatalities in Germany was 1,394 in 2007 and 1,333 in 2016, the year in which about 63,000 Americans suffered a fatal opioid overdose.
Nevertheless, Germany is second only to the United States by volume of opioid prescriptions. In both countries, opioids are still prescribed for chronic pain. Even still, while the United States leads the world in opioid overdoses, Germany is following the European tendency of minimizing the harmful effects which opioids inflict on society.
The Effects Of Harm Reduction Strategies
According to Dr. Peter Raiser of the German Center for Addiction Issues, “among the most important reasons we do not face a similar opioid crisis seems to be a more responsible and restrained practice of prescription.” The German healthcare system is primarily state-funded, with only a minority of its costs covered by private insurance. Consequently, German doctors are less susceptible to pressure from Big Pharma to write unnecessary opioid prescriptions, a major contributing factor to the opioid crisis in the United States.
“Here in Germany, they prescribe opiates if all the other drugs don’t work,” Dr. Dieter Naber of the University of Hamburg explained while commenting on the study. The German healthcare system readily pays for alternatives to opioids for patients who suffering pain, especially when a patient has a history of addiction. Moreover, Germans who struggle with an opioid use disorder have easier access to addiction treatment, including anti-addiction medications like methadone and buprenorphine.
Additionally, the German healthcare system tends to utilize “harm reduction” strategies that the Organization for Economic Cooperation and Development have classified as “best practices” in response to opioid addiction. Germans with opioid use disorders are better able than Americans to safely use opioids in supervised drug consumption centers and benefit from clean-needle exchanges.
In the United States, such programs are likely to encounter legal obstacles. By contrast, there were at least 24 drug consumption centers in six German states in 2019. The centers prevent people from suffering overdoses or fatal withdrawal and remove them from unregulated markets for illegal drugs. With prescriptions controls, affordable treatment, and harm reduction measures, Germany suffers less addiction and sustains fewer casualties despite the prevalence of opioids in the country.
Nathan Yerby is a writer and researcher. He is a graduate of the University of Central Florida.
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